Forms
Welcome to Corona Kids Dental. Thank you for taking the time to fill out our Patient Forms. Please select a tab below for your forms. Completely filled forms help us provide highest quality care for your child. If you have any questions, please give us a call. We are happy to assist you.
If you are using Internet Explorer 8, and the forms don't appear after you click on the tab, then please follow this link for instruction of turn on the compatibility view mode.
New Patient Forms
The following are our new patient forms!
At your own leisure, please click on each of them; either
1. (preferred method) fill them out right on your computer, then print them out,
or alternatively...
2. print them out, then fill them out by pen.
Please bring the 3 completed forms, your driver's license, and dental insurance cards to your child's first appointment. Thank you.
Registration Form
Medical and Dental History Form
Office Policies and Exam Consent Form
For your reference, please also download our Notice of Privacy Policies pertaining to our obligations to your privacy rights.
Notice of Privacy Policies
At your own leisure, please click on each of them; either
1. (preferred method) fill them out right on your computer, then print them out,
or alternatively...
2. print them out, then fill them out by pen.
Please bring the 3 completed forms, your driver's license, and dental insurance cards to your child's first appointment. Thank you.
Registration FormMedical and Dental History FormOffice Policies and Exam Consent FormFor your reference, please also download our Notice of Privacy Policies pertaining to our obligations to your privacy rights.
Notice of Privacy Policies
Recall Exam Forms
The following are our recall exam forms!
At your own leisure, please click on each of them; either
1. (preferred method) fill them out right on your computer, then print them out,
or alternatively...
2. print them out, then fill them out by pen.
Please bring the 2 completed forms, your driver's license, and dental insurance cards to your child's recall exam appointment. Thank you.
Office Policies and Exam Consent Form
For your reference, please also download our Notice of Privacy Policies pertaining to our obligations to your privacy rights.
Notice of Privacy Policies
At your own leisure, please click on each of them; either
1. (preferred method) fill them out right on your computer, then print them out,
or alternatively...
2. print them out, then fill them out by pen.
Please bring the 2 completed forms, your driver's license, and dental insurance cards to your child's recall exam appointment. Thank you.
Office Policies and Exam Consent FormFor your reference, please also download our Notice of Privacy Policies pertaining to our obligations to your privacy rights.
Notice of Privacy Policies
